Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation

Background: Recent observational studies have shown that patients with chronic kidney disease (CKD) have higher risk of atrial fibrillation (AF) recurrence and, therefore, the value of catheter ablation therapy in patients with CKD has been doubted. The purpose of this meta-analysis was to systematically analyze the effect of CKD on recurrence of AF following catheter ablation.Methods: PubMed and Cochrane clinical trials databases were searched until August 2012. Of the 1966 initially identified studies, 4 observational studies with 1379 patients were analyzed.Results: The meta-analysis of these studies showed that CKD was associated with higher AF recurrence rate following single catheter ablation (HR = 1.96, 95% CI 1.35–2.85, p = 0.0004) while there were significant differences between individual trials (p = 0.07 and I2 = 58%). Sensitivity analysis suggested that this outcome was stable. A subgroup analysis showed that CKD has higher recurrent risk in patients with 100% paroxysmal AF (HR = 2.45, 95% CI 1.28–4.70, p = 0.007) than in patients with non 100% paroxysmal AF (HR = 1.65, 95% CI 1.15–2.36, p = 0.006).Conclusions: CKD was associated with higher AF recurrence rate following single catheter ablation. In addition, patients with 100% paroxysmal AF have higher risk than patients with non 100% paroxysmal AF that merits special consideration when evaluating patients for catheter-based AF ablation. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of catheter ablation candidates.

Urea Transporter Physiology Studied in Knockout Mice

In mammals, there are two types of urea transporters; urea transporter (UT)-A and UT-B. The UT-A transporters are mainly expressed in kidney epithelial cells while UT-B demonstrates a broader distribution in kidney, heart, brain, testis, urinary tract, and other tissues. Over the past few years, multiple urea transporter knockout mouse models have been generated enabling us to explore the physiological roles of the different urea transporters. In the kidney, deletion of UT-A1/UT-A3 results in polyuria and a severe urine concentrating defect, indicating that intrarenal recycling of urea plays a crucial role in the overall capacity to concentrate urine. Since UT-B has a wide tissue distribution, multiple phenotypic abnormalities have been found in UT-B null mice, such as defective urine concentration, exacerbated heart blockage with aging, depression-like behavior, and earlier male sexual maturation. This review summarizes the new insights of urea transporter functions in different organs, gleaned from studies of urea transporter knockout mice, and explores some of the potential pharmacological prospects of urea transporters

Diagnostic value of cardiac troponin I and N-terminal pro-B-Type Natriuretic Peptide in cardiac syncope

Objective The study aims to evaluate the diagnostic accuracy of Cardiac Troponin I(cTnI) and N-terminal pro-B-Type Natriuretic Peptide (NT-proBNP) for identifying patients with cardiac syncope. Methods This is a prospective, single-center cohort study of patients presenting with syncope hospitalized from June 21,2018 to May 30, 2019. The Evaluation of Guidelines in Syncope Study (EGSYS), a syncope-specific diagnostic score, was used for diagnostic comparator. Results A total of 118 patients were enrolled (mean age: 69.1 ​± ​12.3 years, 40% female). Compared to patients with reflex, orthostatic, or unexplained syncope, patients adjudicated to have cardiac syncope showed significantly higher cTnI and NT-proBNP plasma concentrations (p ​< ​0.001 for each comparison). The area under the curve (AUC) of cTnI and NT-proBNP were moderate-to-good [0.77–0.78; 95% confidence interval (CI) 0.66–0.86], and was similar to that of EGSYS (0.71, 95%CI 0.60–0.80). Incorporation of cTnI and/or NT-proBNP into the existing EGSYS score significantly improved the diagnostic accuracy (EGSYS ​+ ​cTnI: AUC 0.83; 95%CI 0.74–0.90; EGSYS ​+ ​NT-proBNP: AUC 0.81; 95%CI 0.71–0.89; EGSYS ​+ ​cTnI ​+ ​NT-proBNP: AUC 0.83; 95%CI 0.73–0.90). Conclusions The cTnI and NT-proBNP levels were significantly higher in patients adjudicated to have cardiac syncope and the addition of both biomarkers to the EGSYS score significantly improved the diagnostic value for cardiac syncope

Association between atherosclerosis-related cardiovascular disease and uveitis: A systematic review and meta-analysis

Background: Uveitis is not only an intraocular inflammatory disease, but also an indicator of systemic inflammation. It is unclear whether uveitis can increase the risk of cardiovascular disease (CVD) through the atherosclerotic pathway. Methods: PubMed and Embase databases were searched until 5 September, 2022. Original studies investigating uveitis and cardiovascular events were selected. The random-effects model was used to calculate the difference of groups in pooled estimates. Results: A total of six observational studies that included mainly ankylosing spondylitis (AS) patients were included. Of these, three studies reported data on carotid plaques and carotid intima-media thickness (cIMT) and the other three studies provided data on atherosclerosis-related CVD. No significant difference was found in cIMT between uveitis and controls (MD = 0.01, 95% CI = -0.03-0.04, p = 0.66), consistent with the findings of carotid plaque incidence (OR = 1.30, 95% CI = 0.71-2.41, p = 0.39). However, uveitis was associated with a 1.49-fold increase in atherosclerosis-related CVD (HR = 1.49, 95% CI = 1.20-1.84, p = 0.0002). Conclusions: Uveitis is a predictor of atherosclerosis-related CVD in AS patients. For autoimmune disease patients with uveitis, earlier screening of cardiovascular risk factors and the implementation of corresponding prevention strategies may be associated with a better prognosis. Keywords: ankylosing spondylitis; atherosclerosis; cardiovascular risk; carotid plaques; intima-media thickness; uveiti